Premature epiphysis closure

Introduction Because of the early development of precocious children, it is very likely that the skeletal age will develop ahead of time when the developmental age is reached, and the osteophytes will close in advance, causing them to be generally short after adulthood. The epiphysis is the secondary ossification center that occurs in children at different times after birth. The epiphysis and the epiphyseal plate are the growth areas of the immature long bones of the extremities, and are the weakest and most vulnerable parts of the child's bones. Precocious puberty, female manifestations of breast development, enlargement of the labia minora, estrogen-dependent changes in vaginal mucosal cells, enlargement of the uterus and ovaries, appearance of pubic hair, menarche. Males showed increased testicles and penis, pubic hair, muscles, and thicker sounds. Both men and women have accelerated growth and accelerated bone formation, which can eventually lead to a lifetime high below the target height. In the case of central nervous system diseases such as intracranial tumors, there may be headache, vomiting, vision changes or other neurological symptoms and signs.

Cause

Every child has a bone line at each end of each long bone. It is a bone tissue that grows vigorously. When the bones are old, the bones disappear naturally. That is, the closure of the epiphyseal line means that the natural growth potential has been lost. Children with precocious puberty are closed early due to advance development. Excessive illumination is one of the important causes of precocious puberty in children.

1. Central nervous system organic lesions.

2. Peripheral precocious puberty is transformed.

3. Idiopathic CPP (ICPP) has no organic lesions. 80% to 90% of female children are ICPP; the opposite is true for male children, and more than 80% are organic. It is speculated that this part of precocious puberty is closely related to the stimulation of environmental endocrine disruptors.

an examination

Related inspection

Bone and joint plains of the extremities, serum osteocalcin (BGP), bone mineral density determination

General X-ray can confirm whether the callus is closed in advance.

Diagnostic examination of precocious puberty: detailed and complete medical history, including sexual development, vaginal bleeding, and endocrine drugs. Determination of follicle-stimulating hormone FSH and LH in blood by radioimmunoassay can help distinguish between true and pseudo-precocious puberty. For precocious puberty, there may be an enlarged ovary and a cystic change. Suspected adrenal cortical disease, can be used for retroperitoneal angiography. The positive lateral image of the skull, the size of the saddle is observed to exclude tumors.

1, plasma FSH, LH determination

The basic values of plasma FSH and LH in children with idiopathic precocious puberty can be higher than normal, and it is often difficult to judge. It is necessary to use the GnRH stimulation test, also known as luteinizing hormone releasing hormone (LHRH) stimulation test. Generally, intravenous Gnrh is administered at a dose of 2.5 g/kg/maximum dose 100 g, and serum LH and FSH are measured before injection (basal value) and 30, 60, 90 and 120 minutes after injection, respectively, when the HL peak value is >15 U/ L (female), or >25U/L (male); LH/FSH peak >0.7, LH peak / base value >3, it can be considered that the gonadal axis function has been activated.

2, bone age determination

According to the hand and wrist X-ray film to assess the bone age, the bone development of the disk is ahead of the time, the premature infants generally have a bone age exceeding the actual age.

3, B-ultrasound

Select pelvic B-ultrasound to check the development of girls' ovaries and uterus; boys pay attention to testicular, adrenal cortex and other parts. If pelvic B-ultrasound shows multiple follicles 4mm in the ovary; it is precocious puberty, if a single follicle with a diameter >9mm is found Most of them are cysts. If the ovary is not large and the length of the uterus is >3.5cm and the thickening of the intima is seen, it is mostly exogenous androgen.

4, CT or MRI examination

Patients with suspected intracranial or adrenal diseases should have a CT or MRI of the skull or abdomen.

5, other inspections

According to the clinical manifestations of the children can be further selected.

Differential diagnosis

Need to be identified with the following symptoms:

Long bone epiphyseal calcification: cartilage ectodermal dysplasia syndrome, also known as Ellis-van Creveld congenital malformation syndrome, congenital cartilage calcification disorder heart disease syndrome, cartilage ectodermal dysplasia syndrome, etc., is autosomal recessive hereditary The disease is characterized by short-legged dwarfs, often with congenital heart disease and mental retardation. The newborn baby is in a dwarf state. For example, the long bones of the limbs are short and thick, the distal fingers (toes) are particularly small, and multiple fingers (toes) can appear, hair and teeth develop poorly, and the long bones of the whole body are incompletely calcified.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.